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O'Mathúna DP. Nursing Ethics Education. Nurs Clin North Am 2022; 57:613-625. [DOI: 10.1016/j.cnur.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Thomann M, Kombo B, Musyoki H, Masinya K, Kuria S, Kyana M, Musimbi J, Lazarus L, Blanchard J, Bhattacharjee P, Lorway R. Remaking the Technosubject: Kenyan Men Contextualizing HIV Self-Testing Technologies. Med Anthropol 2022; 41:272-286. [PMID: 35129411 DOI: 10.1080/01459740.2022.2027405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Kenyan government offers free HIV self-testing kits to men who have sex with men. The value of self-testing is based on the imaginary of an autonomous technosubject empowered to independently control testing services, thereby "freed," through technology, from the social conditions that might inhibit health services utilization. Following a community-centered collaborative approach, community researchers interviewed their peers who examined and reacted to the technology. Participants reframed the technosubject as intertwined with the social world and the testing kit itself as an object that exerts agency and possesses affective potential. Attending to these socio-material relationalities offers insights into program planning.
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Affiliation(s)
| | | | | | | | - Samuel Kuria
- Minority Person's Empowerment Program, Thika, Kenya
| | - Martin Kyana
- HIV & AIDS People's Alliance of Kenya, Mombasa, Kenya
| | - Janet Musimbi
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | | | - Parinita Bhattacharjee
- University of Manitoba, Winnipeg, Canada.,Partners for Health and Development in Africa, Nairobi, Kenya
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Greaney AM, Flaherty S. Self-care as care left undone? The ethics of the self-care agenda in contemporary healthcare policy. Nurs Philos 2019; 21:e12291. [PMID: 31883181 DOI: 10.1111/nup.12291] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 10/20/2019] [Accepted: 11/11/2019] [Indexed: 11/28/2022]
Abstract
Self-care, or self-management, is presented in healthcare policy as a precursor to patient empowerment and improved patient outcomes. Alternatively, critiques of the self-care agenda suggest that it represents an over-reliance on individual autonomy and responsibility, without adequate support, whereby 'self-care' is potentially unachievable and becomes 'care left undone'. In this sense, self-care contributes to a blame culture where ill-health is attributed to personal behaviours or lack thereof. Furthermore, self-care may represent a covert form of rationing, as the fiscal means to enable effective self-care and supplement, or replace, self-care capacities, is not provided. This paper explores these arguments through a contemporary ethical analysis of the self-care agenda. The terms self-care and self-management are used interchangeably throughout whereby self-management is understood as a point in the wider self-care continuum.
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Affiliation(s)
- Anna-Marie Greaney
- Department of Nursing and Healthcare Sciences, Institute of Technology, Tralee, Ireland
| | - Sinead Flaherty
- Department of Nursing and Healthcare Sciences, Institute of Technology, Tralee, Ireland
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Pedersen B, Uhrenfeldt L, Jacobsen HR, Jørgensen L. The role of responsibility in oncological emergency telephone calls. Nurs Ethics 2019; 26:2071-2084. [PMID: 30961433 DOI: 10.1177/0969733019839214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Patients and their caregivers are expected to take joint responsibility for reporting symptoms and seeking medical assistance, for example, by calling oncology emergency telephones or other helplines during a cancer trajectory. RESEARCH OBJECTIVE The aim was to explore the meaning of responsibility as it appeared in patients' or caregivers' experiences of calling an oncological emergency telephone. DESIGN, PARTICIPANTS AND CONTEXT Inspired by qualitative description and qualitative content analysis, a secondary analysis of data from interviews with 12 participants calling the oncological emergency telephone at a Danish university hospital was performed. ETHICAL CONSIDERATIONS The project observes demands for safekeeping data and all regulations concerning research ethics in agreement with the Nordic Nurses Federation and the Danish Health Act. FINDINGS Two main themes emerged: (1) to act responsibly as a patient or caregiver was to 'be watchful and alert', 'report symptoms the right way' and 'do crosschecking' and (2) to deal with the burden of responsibility was to 'feel safe when dealing with the burden of responsibility' and 'be relieved from the burden of responsibility'. DISCUSSION Too much responsibility and a potential imbalance between healthcare professionals' expectations and callers' knowledge and capacity to act may place additional burdens on the callers, which may be eased by person-centred care. CONCLUSION The meaning of responsibility appeared in the participants' capacity to act, where they observed, assessed and reported symptoms and controlled prescribed treatments as well as shared or handed over the responsibility to the healthcare providers. Thus, the analysis provided essential knowledge for healthcare professionals on how patients and caregivers handle this responsibility when faced with a cancer disease that is treated on an outpatient basis.
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Burns BL, Bilkey GA, Coles EP, Bowman FL, Beilby JP, Pachter NS, Baynam G, Dawkins HJS, Weeramanthri TS, Nowak KJ. Healthcare System Priorities for Successful Integration of Genomics: An Australian Focus. Front Public Health 2019; 7:41. [PMID: 30915324 PMCID: PMC6421399 DOI: 10.3389/fpubh.2019.00041] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 02/14/2019] [Indexed: 12/18/2022] Open
Abstract
This paper examines key considerations for the successful integration of genomic technologies into healthcare systems. All healthcare systems strive to introduce new technologies that are effective and affordable, but genomics offers particular challenges, given the rapid evolution of the technology. In this context we frame internationally relevant discussion points relating to effective and sustainable implementation of genomic testing within the strategic priority areas of the recently endorsed Australian National Health Genomics Policy Framework. The priority areas are services, data, workforce, finances, and person-centred care. In addition, we outline recommendations from a government perspective through the lens of the Australian health system, and argue that resources should be allocated not to just genomic testing alone, but across the five strategic priority areas for full effectiveness.
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Affiliation(s)
- Belinda L. Burns
- Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, Perth, WA, Australia
| | - Gemma A. Bilkey
- Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, Perth, WA, Australia
- Office of the Chief Health Officer, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, Perth, WA, Australia
| | - Emily P. Coles
- Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, Perth, WA, Australia
| | - Faye L. Bowman
- Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, Perth, WA, Australia
| | - John P. Beilby
- PathWest Laboratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- Faculty of Health and Medical Sciences, School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Nicholas S. Pachter
- Genetic Services of Western Australia, King Edward Memorial Hospital, Department of Health, Government of Western Australia, Subiaco, WA, Australia
- Faculty of Health and Medical Sciences, School of Medicine, The University of Western Australia, Crawley, WA, Australia
| | - Gareth Baynam
- Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, Perth, WA, Australia
- Genetic Services of Western Australia, King Edward Memorial Hospital, Department of Health, Government of Western Australia, Subiaco, WA, Australia
- Western Australian Register of Developmental Anomalies, Department of Health, King Edward Memorial Hospital, Government of Western Australia, Subiaco, WA, Australia
| | - Hugh J. S. Dawkins
- Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, Perth, WA, Australia
- Faculty of Health and Medical Sciences, School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia
- Sir Walter Murdoch School of Policy and International Affairs, Murdoch University, Murdoch, WA, Australia
- School of Public Health, Curtin University of Technology, Bentley, WA, Australia
| | - Tarun S. Weeramanthri
- Office of the Chief Health Officer, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, Perth, WA, Australia
- Faculty of Health and Medical Sciences, School of Population and Global Health, The University of Western Australia, Crawley, WA, Australia
| | - Kristen J. Nowak
- Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, Perth, WA, Australia
- Faculty of Health and Medical Sciences, School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia
- Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, WA, Australia
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Ling DL, Yu HJ, Guo HL. Truth-telling, decision-making, and ethics among cancer patients in nursing practice in China. Nurs Ethics 2017; 26:1000-1008. [PMID: 29183249 DOI: 10.1177/0969733017739783] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Truth-telling toward terminally ill patients is a challenging ethical issue in healthcare practice. However, there are no existing ethical guidelines or frameworks provided for Chinese nurses in relation to decision-making on truth-telling of terminal illness and the role of nurses thus is not explicit when encountering this issue. OBJECTIVES The intention of this paper is to provide ethical guidelines or strategies with regards to decision-making on truth-telling of terminal illness for Chinese nurses. METHODS This paper initially present a case scenario and then critically discuss the ethical issue in association with ethical principles and philosophical theories. Instead of focusing on attitudes toward truth disclosure, it aims to provide strategies regarding this issue for nurses. It highlights and discusses some of the relevant ethical assumptions around the perceived role of nurses in healthcare settings by focusing on nursing ethical virtues, nursing codes of ethics, and philosophical perspectives. And Confucian culture is discussed to explicate that deontology does not consider family-oriented care in China. CONCLUSION Treating each family individually to explore the family's beliefs and values on this issue is essential in healthcare practice and nurses should tailor their own approach to individual needs regarding truth-telling in different situations. Moreover, the Chinese Code of Ethics should be modified to be more specific and applicable. Finally, a narrative ethics approach should be applied and teamwork between nurses, physicians and families should be established to support cancer patients and to ensure their autonomy and hope. ETHICAL CONSIDERATIONS This paper was approved by the Ethics Committee of The Second Affiliated Hospital of Guangzhou Medical University. The authors have obtained consent to use the case study and it has been anonymised to preserve the patient's confidentiality.
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Affiliation(s)
- Dong-Lan Ling
- The Second Affiliated Hospital of Guangzhou Medical University, China
| | - Hong-Jing Yu
- The Second Affiliated Hospital of Guangzhou Medical University, China
| | - Hui-Ling Guo
- The Second Affiliated Hospital of Guangzhou Medical University, China
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Cleary-Holdforth J. Evidence-Based Practice: An Ethical Perspective. Worldviews Evid Based Nurs 2017; 14:429-431. [PMID: 29165870 DOI: 10.1111/wvn.12263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 10/27/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Joanne Cleary-Holdforth
- Joanne Cleary-Holdforth, Assistant Professor, Programme Chair-MSc in Integrative Counselling and Psychotherapy, School of Nursing and Human Sciences, Faculty of Science and Health, Dublin City University
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Abstract
Despite flourishing as a multidisciplinary subject, the predominant view in bioethics today is based on Anglo-American thought. This has serious implications for a global bioethics that needs to be contextualized to local cultures and circumstances in order to be relevant. Being the largest continent on the earth, Asia is home to a variety of cultures, religions and countries of different economic statuses. While the practice of medicine in the East and West may be similar, its ethical practices do differ. Thus, the Western understanding of autonomy may not be wholly applicable in the Asian setting, especially in the setting of breaking bad news, giving consent, determining best interests and deciding on end-of-life care. This article explores these topics in depth, attempting to find shared integrating factors, but at the same time arguing for a modified ethical application of autonomy, based on Asian beliefs.
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Frochen S, Mehdizadeh S. Functional Status and Adaptation: Measuring Activities of Daily Living and Device Use in the National Health and Aging Trends Study. J Aging Health 2017; 30:1136-1155. [DOI: 10.1177/0898264317707299] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: The objective of this study is to evaluate the functional status and adaptation of older Americans and discover the factors that contribute to device use. Method: Using the community participants’ portion of the first round of National Health and Aging Trends Study (NHATS), we demonstrate the prevalence of device use and reduction in activities, creating a multilevel measure of activities of daily living (ADL) functionality as compared with Katz’s dichotomous measure. In determining whether adaptation is universal irrespective of age, sex, race, living arrangement, and income, or dependent on these variables, we create a measure of device use, performing a path analysis of the device use measure and sociodemographic variables, with disability score as an intervening measure. Results: ADL functionality becomes more nuanced between the Katz-ADL and NHATS-ADL. Age, sex, and living arrangement were predictors of device use; income was indirectly, whereas race was not. Discussion: When assessors design service plans, consideration should be given to older adults’ ability, capacity, and resources to adapt.
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Moilanen T, Pietilä AM, Coffey M, Kangasniemi M. Adolescents’ health choices related rights, duties and responsibilities: An integrative review. Nurs Ethics 2016; 25:418-435. [DOI: 10.1177/0969733016654316] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Although the link between adolescents’ health choices in relation to rights, duties and responsibilities is acknowledged, little is studied in this subject. Aim: To identify, describe and synthesize previous studies on adolescents’ health choices in relation to rights, duties and responsibilities. Ethical considerations: Ethical approval is not needed as it is an integrative review of published literature. Method: The integrative review was used to review and synthesize current knowledge. Electronic and manual searches from 2009 to March 2014 were used to systematically identify earlier studies. Results: The review identified 13 studies. Adolescents’ health choices were linked to unsuccessfully exercised rights, arising from questioned autonomy and freedom, and their duties were hardly mentioned. Conclusion: Research into adolescents’ health choices in relation to their rights, duties and responsibilities is still methodologically fragmented. In future, more research is needed to support adolescents’ health promotion initiatives and increase their involvement opportunities.
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Affiliation(s)
| | - Anna-Maija Pietilä
- University of Eastern Finland, Finland; Kuopio Social and Healthcare Services, Finland
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Youngs J, Hooper C. Ethical implications of HIV self-testing. JOURNAL OF MEDICAL ETHICS 2015; 41:809-813. [PMID: 26276789 DOI: 10.1136/medethics-2014-102599] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 07/23/2015] [Indexed: 06/04/2023]
Abstract
In April 2015, the first legally approved HIV self-testing kit went on sale in the UK-except Northern Ireland where they remain illegal. These tests allow individuals to test their HIV status and read the result in the privacy of their own home, much like a home pregnancy test. This paper explores the ethical implications of HIV self-testing. We conclude that there are no strong ethical objections to self-testing being made widely available in the UK. Pretest counselling for an HIV test is not an ethical necessity, and self-testing has the potential to increase early diagnosis of HIV infection and thus improve prognosis and reduce ongoing transmission. Self-testing kits might also empower people and promote autonomy by allowing people to dictate the terms on which they test their HIV status. We accept that there are some potential areas of concern. These include the possibility of user error with the tests, and the concern that individuals may not present to health services following a reactive result. False negatives have the potential to cause harm if the 'window period' is not understood, and false positives might produce psychological distress. There is, however, little evidence to suggest that self-testing kits will cause widespread harm, and we argue that the only way to properly evaluate whether they do cause significant harm is to carefully evaluate their use, now that they are available on the market.
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Affiliation(s)
- Jonathan Youngs
- Department of Renal Medicine, St George's Healthcare NHS Trust, St George's Hospital, London, UK
| | - Carwyn Hooper
- Institute of Medical and Biomedical Education, St George's University of London, London, UK
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Scott PA. Unsupervised self-testing as part public health screening for HIV in resource-poor environments: some ethical considerations. AIDS Behav 2014; 18 Suppl 4:S438-44. [PMID: 24974124 DOI: 10.1007/s10461-014-0833-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The use of unsupervised self-testing as part of a national screening program for HIV infection in resource-poor environments with high HIV prevalence may have a number of attractive aspects, such as increasing access to services for hard to reach and isolated populations. However, the presence of such technologies is at a relatively early stage in terms of use and impact in the field. In this paper, a principle-based approach, that recognizes the fundamentally utilitarian nature of public health combined with a focus on autonomy, is used as a lens to explore some of the ethical issues raised by HIV self-testing. The conclusion reached in this review is that at this point in time, on the basis of the principles of utility and respect for autonomy, it is not ethically appropriate to incorporate unsupervised HIV self-testing as part of a public health screening program in resource-poor environments.
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Affiliation(s)
- P Anne Scott
- School of Nursing and Human Sciences, Dublin City University, Collins Ave, Dublin 9, Ireland,
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Tofan G, Bodolica V, Spraggon M. Governance mechanisms in the physician-patient relationship: a literature review and conceptual framework. Health Expect 2013; 16:14-31. [PMID: 22882293 PMCID: PMC5060640 DOI: 10.1111/j.1369-7625.2012.00807.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2012] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The physician-patient relationship is a critical component of the integrated approach to excellence in health-care delivery. Although commonly modelled within the boundaries of the agency theory and regarded as synonymous to an agent-principal interaction, there exists only a sparse understanding about the most effective ways of governing it. OBJECTIVE This article undertakes a selective review of the growing body of research on the governance of the physician-patient relationship to discuss the current state of the knowledge in the field and suggest promising avenues for further exploration. FINDINGS On the basis of an extensive analysis of the relevant literature, we identify two emerging streams of inquiry on the trust-based (i.e. trust and ethical oversight) and distrust-based (i.e. patient information-empowerment and decision-making authority) governance mechanisms of the physician-patient relationship and discuss the key findings within each stream. DISCUSSION To conciliate the on-going scholarly debate concerning the efficacy of trust- and distrust-based mechanisms, we draw the foundations of a conceptual framework which might serve as a guide for more integrative research endeavours on the governance of the physician-patient relationship.
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Affiliation(s)
- Gabriela Tofan
- School of Public HealthState University of Medicine and Pharmacy “Nicolae Testemitanu”ChisinauRepublic of Moldova
| | - Virginia Bodolica
- Department of ManagementSchool of Business and ManagementAmerican University of SharjahSharjahUnited Arab Emirates
| | - Martin Spraggon
- Department of ManagementSchool of Business and ManagementAmerican University of SharjahSharjahUnited Arab Emirates
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Ten Have H, Gordijn B. Regions, concepts and integrations. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2012; 15:363-364. [PMID: 23010985 DOI: 10.1007/s11019-012-9438-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Accepted: 09/16/2012] [Indexed: 06/01/2023]
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